Dr Houston has argued against the use of diuretics in the management of hypertension for the past 20 years. He continues to ignore the results of every major clinical trial in which diuretics were used as initial therapy. These trials have repeatedly demonstrated a reduction in morbidity and mortality, not just from cerebrovascular disease but from coronary heart disease events. In his letter, he misquotes our ALLHAT editorial. We did not say that thiazide diuretics do not cause "metabolic abnormalities." The correct quote was "Although the use of thiazide diuretics resulted in certain metabolic changes, there was little evidence that these were of major clinical significance in most patients."1 The use of diuretics may cause some increase in insulin resistance, some hypokalemia, a slight, mostly short-term increase in cholesterol levels and uric acid elevations, especially when taken in large doses, but are these changes of clinical significance?